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The QMB program is a state program that helps covers the cost of Medicare premiums, deductibles and coinsurance that Medicare beneficiaries usually pay. You may be eligible for the QMB program if you are entitled to Medicare Part A coverage, and have limited income and resources. If you are eligible, your state's Medicaid program may pay for your Medicare Part B premium, Part A and Part B deductibles, and coinsurance.
Although the rules may vary from state to state, in general, you must meet the following requirements in order to be eligible for the QMB program:
The QMB program covers the cost of Medicare premiums, deductibles and coinsurance that Medicare beneficiaries usually pay. It means that your state covers these Medicare costs for you, and you have to pay only for anything that Medicare normally does not cover. QMB does not supplement your Medicare coverage but instead ensures that you will not be precluded from coverage because you cannot afford to pay the costs associated with Medicare.
Keep in mind that some states require you to pay a small co-payment when you see a doctor.
The Specified Low-Income Medicare Beneficiary Program
If your income is too high to qualify for QMB but is not more than 20 percent above the federal income poverty level, you may receive Specified Low-Income Medicare Beneficiary (SLMB) coverage, which pays for your Medicare Part B monthly premium only. You will, however, pay for Medicare deductibles, coinsurance, and any care not covered by Medicare. The eligibility requirements are the same as those under the QMB program except that your income cannot exceed the national poverty level by more than 20 percent.
The Qualifying Individual Program
If your income is too high for help under SLMB, you may qualify under the Qualifying Individual (QI) program. If your income is more than 20 percent but no more than 35 percent above the national poverty level, your state may pay your Medicare Part B premium.
The QI program must be applied for each year because assistance is provided from a limited pool of funds on a first-come, first-served basis. Individuals who received the benefit in the last month of the previous year will be given priority.
Another program called the Qualified Disabled and Working Individual Program pays the Medicare Part A premiums only for disabled individuals in work incentive programs.
If you have Medicare Part A and think you qualify for assistance, you must apply for Medicaid through a state, county, or local medical assistance office. If you aren't receiving Medicare Part A, but you believe you qualify, contact the Social Security Administration.
Individual monthly income limit*
Married couple monthly income limit*
Individual resource limit
Married couple resource limit
Program helps pay for:
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Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1, of each year.
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Blue Cross Blue Shield - Illinois
Blue Cross Blue Shield - Montana
Blue Cross Blue Shield - New Mexico
Blue Cross Blue Shield - Oklahoma
Blue Cross Blue Shield - Texas
Blue Shield of California
Capital Blue Cross
Cigna Health Spring
Premera Blue Cross
Scott & White
Vibra Health Plan
Last Revised 11/15/2017